I have a post op knee patient (distal realignment, MPFL reconstructions) who was diagnosed with a posterior tibial vein DVT and has now been on Lovenox for 3 days. She is early post op and so one of our main goals is getting quad activation. I was always taught no estim on these patients with an active DVT. However, I am wondering when folks would consider the use of NMES safe in this situation. I.E. at what point would the clot be stable enough to apply NMES to the quads fairly near the clot site.

I usually consult the below reference b/c I think it is pretty complete. They list it as a contraindication but obviously there has to be a point that one could use the modality I'm just not sure what that point in time is.